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Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock.
Crit Care Med. 2002 Jun; 30(6):1365-78.CC

Abstract

BACKGROUND

The Institute of Medicine has called for the development of clinical guidelines and practice parameters to develop "best practice" and potentially improve patient outcome.

OBJECTIVE

To provide American College of Critical Care Medicine clinical guidelines for hemodynamic support of neonates and children with septic shock.

SETTING

Individual members of the Society of Critical Care Medicine with special interest in neonatal and pediatric septic shock were identified from literature review and general solicitation at Society of Critical Care Medicine Educational and Scientific Symposia (1998-2001).

METHODS

The MEDLINE literature database was searched with the following age-specific keywords: sepsis, septicemia, septic shock, endotoxemia, persistent pulmonary hypertension, nitric oxide, and extracorporeal membrane oxygenation. More than 30 experts graded literature and drafted specific recommendations by using a modified Delphi method. More than 30 more experts then reviewed the compiled recommendations. The task-force chairman modified the document until <10% of experts disagreed with the recommendations.

RESULTS

Only four randomized controlled trials in children with septic shock could be identified. None of these randomized trials led to a change in practice. Clinical practice has been based, for the most part, on physiologic experiments, case series, and cohort studies. Despite relatively low American College of Critical Care Medicine-graded evidence in the pediatric literature, outcomes in children have improved from 97% mortality in the 1960s to 60% in the 1980s and 9% mortality in 1999. U.S. hospital survival was three-fold better in children compared with adults (9% vs. 27% mortality) in 1999. Shock pathophysiology and response to therapies is age specific. For example, cardiac failure is a predominant cause of death in neonates and children, but vascular failure is a predominant cause of death in adults. Inotropes, vasodilators (children), inhaled nitric oxide (neonates), and extracorporeal membrane oxygenation can be more important contributors to survival in the pediatric populations, whereas vasopressors can be more important contributors to adult survival.

CONCLUSION

American College of Critical Care Medicine adult guidelines for hemodynamic support of septic shock have little application to the management of pediatric or neonatal septic shock. Studies are required to determine whether American College of Critical Care Medicine guidelines for hemodynamic support of pediatric and neonatal septic shock will be implemented and associated with improved outcome.

Authors+Show Affiliations

Children's Hospital of Pittsburgh, Division of Critical Care Medicine, 15213, USA. carcilloj@anes.upmc.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

12072696

Citation

Carcillo, Joseph A., et al. "Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Patients in Septic Shock." Critical Care Medicine, vol. 30, no. 6, 2002, pp. 1365-78.
Carcillo JA, Fields AI, American College of Critical Care Medicine Task Force Committee Members. Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med. 2002;30(6):1365-78.
Carcillo, J. A., & Fields, A. I. (2002). Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Critical Care Medicine, 30(6), 1365-78.
Carcillo JA, Fields AI, American College of Critical Care Medicine Task Force Committee Members. Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Patients in Septic Shock. Crit Care Med. 2002;30(6):1365-78. PubMed PMID: 12072696.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. AU - Carcillo,Joseph A, AU - Fields,Alan I, AU - ,, PY - 2002/6/20/pubmed PY - 2002/7/12/medline PY - 2002/6/20/entrez SP - 1365 EP - 78 JF - Critical care medicine JO - Crit Care Med VL - 30 IS - 6 N2 - BACKGROUND: The Institute of Medicine has called for the development of clinical guidelines and practice parameters to develop "best practice" and potentially improve patient outcome. OBJECTIVE: To provide American College of Critical Care Medicine clinical guidelines for hemodynamic support of neonates and children with septic shock. SETTING: Individual members of the Society of Critical Care Medicine with special interest in neonatal and pediatric septic shock were identified from literature review and general solicitation at Society of Critical Care Medicine Educational and Scientific Symposia (1998-2001). METHODS: The MEDLINE literature database was searched with the following age-specific keywords: sepsis, septicemia, septic shock, endotoxemia, persistent pulmonary hypertension, nitric oxide, and extracorporeal membrane oxygenation. More than 30 experts graded literature and drafted specific recommendations by using a modified Delphi method. More than 30 more experts then reviewed the compiled recommendations. The task-force chairman modified the document until <10% of experts disagreed with the recommendations. RESULTS: Only four randomized controlled trials in children with septic shock could be identified. None of these randomized trials led to a change in practice. Clinical practice has been based, for the most part, on physiologic experiments, case series, and cohort studies. Despite relatively low American College of Critical Care Medicine-graded evidence in the pediatric literature, outcomes in children have improved from 97% mortality in the 1960s to 60% in the 1980s and 9% mortality in 1999. U.S. hospital survival was three-fold better in children compared with adults (9% vs. 27% mortality) in 1999. Shock pathophysiology and response to therapies is age specific. For example, cardiac failure is a predominant cause of death in neonates and children, but vascular failure is a predominant cause of death in adults. Inotropes, vasodilators (children), inhaled nitric oxide (neonates), and extracorporeal membrane oxygenation can be more important contributors to survival in the pediatric populations, whereas vasopressors can be more important contributors to adult survival. CONCLUSION: American College of Critical Care Medicine adult guidelines for hemodynamic support of septic shock have little application to the management of pediatric or neonatal septic shock. Studies are required to determine whether American College of Critical Care Medicine guidelines for hemodynamic support of pediatric and neonatal septic shock will be implemented and associated with improved outcome. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/12072696/Clinical_practice_parameters_for_hemodynamic_support_of_pediatric_and_neonatal_patients_in_septic_shock_ L2 - https://dx.doi.org/10.1097/00003246-200206000-00040 DB - PRIME DP - Unbound Medicine ER -